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Washington rates for HCPCS A4402

Lubricant, per oz

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.26 / $2.86 / $2.99
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.62 / $1.26 / $2.64
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.95 / $80.00 / $80.00
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.56 / $1.96 / $23.09
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.72 / $1.34 / $1.34
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.13 / $1.13 / $1.53
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.69 / $2.29 / $4.23
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.69 / $2.54 / $4.23
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.54 / $1.72 / $1.89
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.90 / $2.18 / $2.23
Pacific Source
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.96 / $2.23 / $2.23
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.85 / $1.95 / $3.61
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.85 / $2.11 / $3.92
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.78 / $1.90 / $2.45
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.88 / $0.95 / $1.80
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.11 / $1.45 / $1.45